Surgical device and methods

ABSTRACT

A surgical system for treating targeted tissue in a fluid-filled working space includes a probe having an elongated shaft extending from a proximal end to a working end. A tissue-receiving window formed in the working end opens to a passageway in the elongated shaft, and a motor moves an electrode across the tissue-receiving window to resect tissue. A radiofrequency (RF) current source is coupled to the electrode, and a controller operatively connected to the motor and the RF source. In some instances, the controller actuates movement of the electrode in response to electrode contact with the targeted tissue. In some instances, the controller actuates movement of the electrode in a single stroke to perform biopsy.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional No. 62/891,815 (Attorney Docket No. 42005-715.101), filed Aug. 26, 2019, the entire content of which is incorporated herein by reference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates to devices and methods for resecting and removing tissue from an interior of a patient's body, for example in a transurethral resection of prostate tissue to treat benign prostatic hyperplasia or the resection of bladder tumors.

Electrosurgical cutting devices often comprise a shaft or sleeve having a tissue extraction lumen with one or more radio frequency (RF) cutting blades arranged to resect tissue which may then be drawn into the extraction lumen, often via vacuum assistance through a cutting window. Most such electrosurgical tissue cutting devices rely on manually engaging the cutting window against the target tissue to be resected. While such manual engagement is often sufficient, in other cases, such as in laparoscopic procedures having limited access and field of view, the target tissue can be difficult to visualize prior to resection and, in particular, it can be difficult to assure that the optimum target site has been engaged by the cutting window. For these reasons, it would be desirable to provide improved electrosurgical cutting tools having improved visibility and ability engage and immobilize tissue prior to cutting and to extract the tissue from tools after cutting.

For resection of remote tissue sites, such as the prostate, it is usually desirable to introduce the surgical cutter through a tubular introducer device. Though such tubular introducers can be advanced “blind,” i.e., without direct optical visualization, it is frequently advantageous to provide such introducers with direct visualization. For example, it would be desirable to use an endoscope to observe the urethra while transurethrally advancing an introducer sheath for subsequent resection of the prostrate. Once the introducer sheath is in place and the surgical cutter has been introduced, however, it will still be necessary to move a cutter element on the surgical cutter to resect the tissue. Heretofore, this has typically been accomplished by manually reciprocating a cutter assembly on the tissue resecting apparatus. Manual resection, while generally effective, can be difficult to control and, in particular, can be difficult to coordinate with other aspects of the resection procedure, such as applying RF power, applying a vacuum to aspirate tissue fragments and debris, and the like.

For example, even when viewing a target site, it can be difficult to know when an electrode has made sufficient contact with a target tissue to start cutting and/or ablation. When cutting is associated with biopsy, it can sometimes be difficult to control the extent of tissue resection.

For these reasons, it would be desirable to provide improved apparatus, systems and methods for resecting tissue in various biopsy and other procedures. It would be particularly desirable to provide apparatus, systems and methods which provide improved control of tissue resection including but not limited to enhanced initiation and coordination of cutter movement control, cutting power control, vacuum aspiration control, and the like. At least some of these objectives will be met by the inventions described below.

2. Listing of Background Art

Related patents and published applications include U.S. Pat. Nos. 8,221,404; 7,744,595; U.S. Pat. Publ. 2014/0336643; U.S. Pat. Publ. 2010/0305565; U.S. Pat. Publ. 2007/0213704; U.S. Pat. Publ. 2009/0270849; U.S. Pat. Publ. 2013/0090642; U.S. Pat. Publ. 2013/0046304; U.S. Pat. Publ. 2013/0172870; U.S. Pat. Publ. 2015/0105791; U.S. Pat. Publ. 2015/0157396; U.S. Pat. Publ. 2016/0089184; U.S. Pat. Publ. 2016/0095615; U.S. Pat. Publ. 2017/0086918; U.S. Pat. Publ. 2017/0181793; and U.S. Pat. Publ. 2018/0071015. See also commonly assigned, published applications: U.S. Pat. Publ. 2014/0336643; U.S. Pat. Publ. 2017/0105748; U.S. Pat. Publ. 2017/0105607; U.S. Pat. Publ. 2017/0333120; U.S. Pat. Publ. 2017/0333119; U.S. Pat. Publ. 2018/0221054; and U.S. Pat. Publ. 2018/0280077.

SUMMARY OF THE INVENTION

The present invention provides apparatus, systems, and methods for performing electrosurgical resections in minimally invasive procedures. While the apparatus, systems, and methods are particularly suitable for performing transurethral resection of the prostate (often referred to as TURP), they will also find use in a variety of other laparoscopic and other endoscopic and endosurgical procedures. The apparatus comprises motor-driven cutters, where the motors are configured to drive both a shaft of the cutter and a cutter electrode, either independently, contemporaneously, or selectively independently and contemporaneously. The systems comprise the cutters together with a digital or other controller configured to coordinate movements of the shaft, electrodes, and other external components such as a radiofrequency power supply (e.g. by selecting a cutting or a coagulation waveform, power, timing, etc.), a negative pressure source, and the like. The methods of the present invention comprise using the apparatus and systems as just described for prostatectomies and other tissue resection procedures.

In a first aspect, the present invention provides a surgical system for treating targeted tissue in a fluid-filled working space. The surgical system comprises a probe with an elongated shaft extending to a working end having a tissue-receiving window that opens to a passageway in the shaft, an electrode, and a motor. The motor is configured to move the electrode across the tissue-receiving window to resect tissue, and a current source configured to be coupled to the electrode. A controller is operatively connected to the motor and the current source, and the controller is configured to initiate movement of the electrode in response to contact of the electrode with the targeted tissue.

In particular embodiments, the current source may comprise an ablative radiofrequency (RF) current source and at least one of a low-level RF source and a low level direct current (DC) source. In such instances, the controller may be configured to determine electrode-tissue contact by monitoring an electrical parameter of a low-level current delivered to the electrode, typically comprising at least one of impedance, capacitance and phase angle, such as a selected threshold level of at least one of impedance and capacitance or a rate of change of at least one of impedance and capacitance.

In particular embodiments, the surgical system of the present invention may further comprise a negative pressure source coupled the passageway adapted for suctioning tissue into the window. The motor drive may be adapted to move the electrode across the window at a rate ranging from 1 Hz to 50 Hz. The controller may be further adapted to stop movement of the electrode in response to an electrical parameter comprising at least one of impedance, capacitance and phase angle. The controller may be further adapted to modulate negative pressure in response to an electrical parameter relating to at least one of impedance, capacitance and phase angle.

In a second aspect, the present invention provides a method of treating targeted tissue in a fluid-filled working space using a probe with an elongated shaft extending to a working end having a tissue-receiving window with a motor-driven electrode that moves across the window. The working end is introduced into the working space proximate the targeted tissue. Movement of the electrode is actuated or initiated in response to electrode contact with the targeted tissue, and current is delivered to the electrode to ignite a plasma around the electrode. Tissue may be resected with the electrode and plasma.

In particular embodiments of these methods, the actuating or initiating step includes monitoring an electrical parameter of current delivered to the electrode, typically utilizing a controller configured to determine electrode-tissue contact by the electrical parameter comprises a selected level of at least one of impedance and capacitance. The methods may further comprise the step of stopping movement of the electrode in response a selected level of at least one of impedance and capacitance. The actuating step may move the electrode across the window at a rate ranging from 1 Hz to 50 Hz.

In particular embodiments of these methods, a negative pressure source communicating with a passageway in the shaft and the window may be activated to suction tissue into the window. In those instances, the negative pressure may be modulated in response to a selected level of at least one of impedance and capacitance.

In a third aspect, the present invention provides a surgical system for obtaining a biopsy sample in a fluid-filled working space. Such biopsy systems comprise a probe with an elongated shaft extending from a proximal end to a working end having a tissue-receiving window that opens to a passageway in the shaft, an electrode, and a motor. The motor is configured to move the electrode across the tissue-receiving window to resect tissue, and a controller is configured or adapted to energize the electrode and actuate movement of the electrode in a single stroke across the window to resect a tissue sample.

In particular embodiments of these biopsy systems, the single stroke may consist of an electrode movement from a first side of the window to an opposing second side of the window. Alternatively, the single stroke may consist of electrode movement from a first side of the window to an opposing second side thereof and back to said first side in a single reciprocation. In such instances, the systems may further comprise a stop mechanism for stopping movement of the electrode at the first side (after a single, unidirectional stroke) or the opposing second side of the window (after a bidirectional reciprocation). In alternative embodiments, the systems may further comprise a selector mechanism coupled to the controller for selecting a predetermined number of strokes (unidirectional or bidirectional) ranging from 1 to 50.

In particular embodiments, these systems may further comprise a negative pressure source coupled the passageway adapted for suctioning tissue into the window. A selector mechanism may be coupled to the controller for selecting a predetermined level of suction provided by the negative pressure source. A selector mechanism may also be coupled to the controller for selecting a predetermined speed of electrode movement, and a stop mechanism may be adapted to stop the motor in response to signals from at least one of a position switch, an encoder coupled to the motor, a stepper motor, an optical sensor or a Hall effect sensor.

In a fourth aspect, the present invention provides a method of obtaining a biopsy sample in a fluid-filled working space comprising providing a probe with an elongated shaft extending to a working end having a tissue-receiving window with a motor-driven electrode that moves across the window. The working end s introduced into the working space proximate the targeted tissue, and movement of the electrode in a single stroke across the window to resect a biopsy sample is initiated.

In particular embodiments of these biopsy methods, the actuating step moves the electrode from a first side of the window to an opposing second side of the window in a single unidirectional stroke. In alternative embodiments, the actuating step moves the electrode from a first side of the window to an opposing second side thereof and back to said first side in one or more bidirectional strokes.

Typically, the actuating step is controlled by a controller, and the controller may be configured to initiate a predetermined number of strokes ranging from 1 to 10. The controller may be further configured to select a predetermined level of suction provided by a negative pressure source communicating with the window. The controller may be still further configured to select a predetermined speed of electrode movement across the window, for example at a rate equivalent to 1 Hz to 50 Hz.

In a fifth aspect, the present invention provides surgical system for obtaining a biopsy sample in a fluid-filled working space comprising a probe with an elongated shaft extending to a working end having a tissue-receiving window that opens to a passageway in the shaft connected to a negative pressure source. A moveable electrode is adapted to move across the window to resect tissue suctioned into the window, and a controller is adapted activate the negative pressure source at at least first and second negative pressure levels for suctioning different volumes of tissue into the window to thereby provide different volume biopsy samples.

In particular embodiments, the controller may be further adapted to control a motor drive for moving the electrode, for example at a rate equivalent to 1 Hz to 50 Hz. The controller may also be adapted to control an electrical source operatively coupled to the electrode.

In other aspects, the present invention provides a tissue resecting device comprising a shaft assembly movably attached to a handle and having a longitudinal axis. A housing is secured to a distal end of the shaft and has a window configured to be fluidly coupled to a negative pressure source. An electrode is disposed in the housing and configured to move relative to the window, and a motor in the handle is adapted to move the electrode across the window.

In an additional specific example, the motor will be adapted to move the electrode at a fixed or adjustable speed or rate relative to the window, e.g. at a rate greater than 1 cycle per second (CPS), often greater than 5 CPS.

The shaft may be operated manually. That is, the user may be able to manually initiate the at least one motor to move the electrode in the housing relative to the window and then manually reciprocate the shaft in an axial stroke relative to the handle. Even when being operated manually, the tissue resecting device will usually be operated through an interface (typically including a radiofrequency (RF) power supply) which may provide for specific operational parameters, often fixed or manually adjustable parameters, such as stroke times, power levels, RF waveforms, and the like, without having feedback control capability.

Often, the tissue resecting device will be provided as part of a tissue resecting system which further comprises a controller which is configured to operate not only the motor, but usually also a RF power source which is coupled to the electrode and also a negative pressure source which may be coupled to the window in the housing. The controller may be further configured or adapted to automatically or manually control at least one motor to stop movement of the electrode in a selected position relative to the window. Alternatively or additionally, the controller may be adapted to stop the electrode in the center of the window. Alternatively or additionally, the controller may be adapted to stop the electrode at an end of the window.

The controller may be adapted in a variety of other different control protocols. For example, the controller may be adapted to control the motor to provide a single movement cycle of the electrode back and forth across the window. That is, the user may be able to cause the controller to initiate only a single pass of the electrode over the window in order to achieve a controlled cutting of tissue. Additionally, the controller will usually be configured to control and coordinate the delivery of negative pressure from the negative pressure source to the housing window and to actuate the at least one motor, usually contemporaneously.

In still further aspects of the systems of the present invention, the controller may be configured to modulate the negative pressure source in response to movement of the electrode relative to the window. For example, the controller may be configured to activate or deactivate the RF source in response to movement of the electrode relative to the window. Still additionally, the controller may be configured to activate or deactivate the RF source to deliver a cutting current waveform or a coagulation waveform to the electrode.

In particular aspects of the present invention as described in detail below, the devices, systems and methods are particularly configured for treating the prostate, optionally under endoscopic visualization. For example, the systems may comprise a RF source configured to deliver RF current alternatively in a cutting waveform and a coagulation waveform to the electrode, a motor configured to move the electrode, and a controller configured to operate the motor and RF source in a first mode delivering a cutting waveform while activating the motor to move the electrode in a second mode delivering a coagulation waveform after de-activating the motor to stop the electrode in a selected stationary position. Such methods for treating the prostate may comprise providing a treatment device with a shaft extending along a longitudinal axis to a distal portion having a window communicating with an aspiration source and a motor driven electrode adapted to move relative to the window. The window is engaged against targeted prostate tissue, and the RF source is operated in a first mode with a cutting waveform delivered to the electrode while activating the motor to move the electrode to resect tissue and thereafter operated in a second mode with a coagulation waveform delivered to the electrode after de-activating the motor to stop the electrode in a selected stationary position to coagulate tissue.

In one particular aspect of the present invention, a tissue imaging and resection device comprises a handle and an introducer sleeve attachable to the handle. Typically, the handle will be permanently affixed to the introducer sleeve, but in other embodiments the handle and introducer sleeve could be detachable. The tissue imaging and resection device further comprises an axially translatable resecting component disposed within the introducer sleeve assembly. The axially translatable resecting component typically has a working end disposed at a distal end thereof where the working end usually includes an electrosurgical or other cutting implement configured to resect tissue. The tissue imaging and resection device will typically further comprise a tubular assembly disposed within the introducer sleeve and having an electronic imaging sensor, a lens, and a light source, disposed at a distal end of the tubular assembly.

In particular aspects of the tissue imaging and resection device, the handle will often carry a motor which is operatively coupled to the resecting component for driving a movable tissue resection element, such as an electrode, blade, or the like, in the resecting component. In specific embodiments, the tissue resection element comprises a radio frequency (RF) electrode of a type that can be connected to a radiofrequency power supply which delivers a cutting current to the electrode in order to allow the electrode to resect tissue as it is advanced there through. In such instances, the tissue imaging and resection device will typically include electromagnetic (EM) shielding between the electronic image sensor and the RF electrode. For example, the electronic image sensor and associated electrical leads may be encased in an electrically conductive tube, cylinder, or elongate hollow structure, typically a metal tube, which is covered with a polymeric or other electrically insulating layer, such as a shrink wrap tubing, over its exterior surface and a similar insulating layer over a lens component coupled to the image sensor.

In still further instances, the introducer sleeve of the tissue imaging and resection devices of the present invention will have a proximal and, a distal end, and a central passage extending along an axis between the proximal and distal ends. In these embodiments, the axially translatable resecting component typically comprises a shaft extending axially through the central passage of the introducer sleeve. The shaft will typically have a resection window near its distal end and an aspiration channel extending from the resection window to a proximal location on the shaft. The proximal location will usually lie within the handle and be configured for coupling to a negative pressure source via a connection in the handle.

In further specific instances, the tubular assembly may comprise at least one tubular member disposed in parallel to the shaft of the axially translatable resecting component within the central passage of the introducer sleeve. The tubular assembly may comprise a single tubular member which carries each of the electronic imaging sensor, lens, and the light source. More typically, however, the tubular assembly will comprise a first tubular member which carries the lens and the electronic imaging sensor and a second tubular member which carries the light source. By separating the imaging components from the light source, e.g., placing only the imaging sensor and associated conductor leads within one electromagnetically isolated structure as described above, and placing the light source in a tubular or other structure, the first and second tubular members may have a total cross-sectional area that is less than a single tubular member and such first and second tubular members may be isolated from one another by electromagnetic shielding to inhibit or prevent interference between the relatively high power light source and the low power imaging sensor. For example, the light source may comprise a light emitting diode (LED) at a distal end of the second tubular member with LED conductor leads extending from a proximal location on the second tubular member to the LED. The first tubular member may further comprise sensor conductors extending from a proximal location thereon to the electronic image sensor. In particular configurations, the sensor conductors are coupled to a circuit board, and all sides and a distal end of the first tubular member are encased in components providing electromagnetic shielding of the image sensor and sensor conductors. In such instances, at least a distal portion of the electromagnetic shielding in the field of view of the lens will be transparent of the lens may be configured to provide such shielding.

In still other specific instances of the tissue imaging and resection devices of the present invention, at least a portion of the second tubular member will be encased in electromagnetic shielding. In such instances, at least a distal portion of the electromagnetic shielding on the second tubular member will also be transparent in order to allow the projection of light from the light source there through.

In still other specific aspects, the present invention provides devices, tools, systems, and methods for electrosurgical treatment of tissue, particularly for performing urological procedures such as resecting prostate tissue, resecting bladder tissue, and the like. The devices and tools of the present invention can be made with very low profiles, typically with diameters or widths at or below 10 mm, often below 6 mm, and frequently as low as 4 mm or less. The low profile devices and tools of the present invention are particularly advantageous as they can be configured to incorporate movable electrodes and other cutters, vacuum-assisted tissue extraction lumens, and other desirable features within the limited tool sizes available.

In one particular aspect, the tissue resection component, comprises an elongated shaft having an electrode assembly at or near a distal end thereof. The elongated shaft has a tissue-receiving window in a working end thereof, where the tissue-receiving window opens to a tissue-extraction lumen which extends along a longitudinal axis of the shaft. The electrode assembly includes a movable electrode which extends in a lateral direction over an exterior of the tissue-receiving window. The electrode assembly is configured to reciprocate the moveable electrode axially over an exterior region of the tissue-receiving window to resect tissue which is drawn inwardly into or through the window, typically by applying a vacuum or negative-pressure to the tissue extraction lumen. The moveable electrode has first and second lateral portions or sides that extend over first and second lateral edges of the tissue-receiving window, thus improving the ability of the electrode to resect or sheer tissue that is received through the window.

The moveable electrode may have a total surface area which is very low, typically in the range from 0.05 in² to 0.25 in². In more specific aspects, the electrode has a surface area less than 0.2 in², often less than 0.15 in², and in some instances less than 0.1 in². In such embodiments, the window will typically have an open area in the range from 8 mm² to 16 mm².

In still other aspects of the present invention, the electrode assembly is configured to reciprocate the moveable electrode with a stroke that extends over proximal and distal edges of the tissue-receiving window. By thus having the movable electrode extend over both the lateral edges and the proximal and distal edges of the tissue receiving window, complete resection of the tissue can be achieved.

In still further specific aspects of the present invention, the electrode assembly comprises a sleeve disposed externally on the electrode shaft, typically over an axial path along an outer cylindrical surface of the shaft. A longitudinal wire member is mounted to reciprocate within a lumen of the external sleeve, and a distal end of the longitudinal wire is attached to or integrated with the first lateral portion of the moveable electrode. Exemplary movable electrodes may thus comprise a lateral extension of the longitudinal electrode wire, e.g., in a hockey stick configuration. As described in more detail below, the lateral extension will typically be curved so that the electrode follows a curved envelope defined by the window which may be in a cylindrical wall of the working end or often in a curved surface that is offset outwardly from the cylindrical surface of the shaft.

The working end of the device may further comprise a ledge adjacent the second lateral edge of the tissue-receiving window, and a distal tip of the second lateral portion of the moveable electrode may travel along a surface of the ledge as the moveable electrode is reciprocated.

In still further aspects of the present invention, the tissue-receiving window is formed in a curved surface of dielectric housing and such a curved surface is outward and asymmetric relative to a cylindrical surface of the shaft. The moveable electrode typically has an arcuate shape with a curvature that conforms to the curvature of the tissue-receiving window.

In still other specific aspects of the present invention, the tissue resecting devices may further comprise a handle attachable to a proximal end of the elongated shaft. The motor drive assembly is typically disposed within the handle. The motor drive assembly may be adapted to axially reciprocate the moveable electrode across the window in the range of 1 Hz to 50 Hz.

Typically, the tissue resecting devices of the present invention will be present in systems comprising a controller adapted to control the motor drive assembly, the negative pressure source, and energy delivery to the movable electrode.

In still other specific aspects of the present invention, the window edges may comprise a dielectric material. For example, the working end may comprise a dielectric housing with the tissue-receiving window disposed in the dielectric housing. In such instances, the lateral edges as well as the proximal and distal edges of the tissue-receiving window will be formed from the dielectric material. The dielectric material may be any one or more of a polymer, a ceramic, a glass, or other suitable dielectric materials.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a view of a tissue resecting system and a block diagram of systems and operating components corresponding to the invention.

FIG. 2 is another perspective view of the system of FIG. 1 from a different angle showing the working end of a tissue-resecting component extending distally from an outer sleeve of the device.

FIG. 3 is a perspective view of a handle of the resecting device of the system of FIGS. 1-2.

FIG. 4A is an enlarged view of the distal end portion of the resecting device of FIGS. 1-2 showing an expandable, resilient structure in a tapered shape for introduction into a patient's body.

FIG. 4B is another view of the distal end portion of the resecting device of FIG. 4A showing the resilient structure in an second, expanded cylindrical shape for introduction of a resecting component therethrough.

FIG. 5 is a view of the distal end portion of FIG. 4B in its expanded cylindrical shape with a resecting component extending distally beyond the resilient structure.

FIG. 6 is a sectional view of the distal end portion of the resecting device and resilient structure of FIG. 4B taken along line 6-6 of FIG. 4B.

FIG. 7 is a perspective view of the working end of a shaft of the tissue-resecting component also shown in FIG. 2, the component having a distal dielectric housing and a reciprocating electrode that is adapted to move axially across the outer surface of a tissue-receiving window.

FIG. 8 is another perspective view of the working end of FIG. 7 from a different angle.

FIG. 9 is a perspective view of a handle of another resecting device that is very similar to that of FIGS. 1-2 except the working end or the tissue-resecting component is different and is shown in FIG. 10.

FIG. 10 is a perspective view of the variation of a working end of a tissue-resecting component of FIG. 9 with a reciprocating electrode.

FIG. 11 is a schematic view device of FIGS. 9 and 10 showing the endoscopic viewing component and electromagnetic shielding that encases the viewing component as well as an LED component.

FIG. 12 is a schematic view of the working end of the device of FIGS. 9 and 10 and its endoscopic viewing component in a patient's bladder and adapted for resecting a bladder tumor.

FIG. 13A is an enlarged view of working end of the probe of FIG. 12.

FIG. 13B is a view of working end of FIG. 13A after being moved into contact with tissue and actuating movement of an energized electrode to resect thin tissue chips.

FIG. 13C is another view of working end of FIGS. 13A-13B after cutting additional thin tissue chips.

FIG. 13D is another view of working end of FIGS. 13A-13C after the probe has resected the bladder tumor.

DETAILED DESCRIPTION OF THE INVENTION

FIGS. 1-2 illustrate an endoscopic, electrosurgical tissue resecting system 50 for use in urological procedures to resect tissue. The system 50 includes a hand-held resecting device 100 and fluid management system 110 consisting of a fluid source 115 for providing fluid inflows or irrigation to a working space and a negative pressure source 120 for aspirating fluids from the working space.

The resecting device 100 is typically a single-use tissue device or probe including a single-use viewing system consisting of a distal electronic imaging sensor 125 with lens 130 (FIG. 4B) coupled to an imaging processor 140 in a console or base unit 145 (see FIGS. 1 and 2). The base unit 145 may optionally carry the fluid management system 110. Additionally, the base unit 145 may carry a microprocessor or controller 150 for controlling all operating parameters of the fluid management system 110, an RF source 155A for energizing the electrosurgical component, an electrical source 155B coupled to a motor drive unit described further below and an LED source 160 for delivering electrical current to at least one LED described further below.

The resecting device 100 has a handle portion 162 that is coupled to an elongated shaft or introducer sleeve assembly 550 that has an outer diameter ranging from about 5 mm to 10 mm, and in one variation is approximately 7 mm in diameter. In a variation, the device is adapted for performing a TURP procedure (transurethral resection of prostate) or a bladder tumor resection procedure and thus the shaft portion has a length suitable for introducing in a transurethral approach to reach the targeted prostate tissue or bladder tissue.

The tissue resecting system 50 includes four functional components which will be described separately. First, the system includes introducer sleeve component that has a soft tapered tip for introducing through body passageway under endoscopic vision wherein the sleeve can be adjusted to a cylindrical, non-tapered shape for advancing the resecting component therethrough. Second, the system 50 includes the RF tissue resecting component with a motor-driven moveable electrode. Third, the system 50 includes the fluid management component 110 as indicated above. Fourth, the system includes an endoscopic viewing component including the imaging sensor 125 and the lens 130.

As can be understood in FIGS. 1, 2, 4A-4B, the resecting device 100 has an integrated introducer sleeve assembly 550 which comprises an outer introducer sleeve or tubular member 552 and an inner sleeve 555 described further below. FIGS. 1-2 show the outer sleeve 552 fixed to the handle 162 which extends to a distal end 558 (FIG. 4A) and which includes a resilient structure 560 that is movable or deformable between a first tapered, rounded-nose shape or configuration (FIG. 4A) for introduction through a body passageway and a second cylindrical shape or configuration (FIG. 4B) that allows for the endoscope sleeve 545 and resecting component 600 to be advanced into or through the distal end of the sleeve assembly 550 and resilient structure 560. The outer introducer sleeve 552 can be a thin-wall stainless steel material with a diameter ranging from about 5 mm to 10 mm.

As best seen in FIG. 4A, which is an enlarged view of the distal end 558 of the sleeve assembly 550 of the FIGS. 1 and 2, the resilient structure 560 is shown in a relaxed (non-tensioned) configuration where it contracts to assume a tapered, conical configuration. In contrast, FIG. 4B show the resilient structure 560 in a tensioned, radially expanded configuration where the outer surface is generally conical and aligned with proximal portions of the sleeve assembly 550.

In FIG. 4A, it can be seen that one variation of outer introducer sleeve 552 comprises a thin-wall metal tubing with a distal portion 565 that comprises a spring material that defines a resilient scaffold including a plurality of spring struts 566 and openings 568 to allow movement of the structure 560 from the relaxed position of FIG. 4A to the tensioned position of FIG. 4B. In one variation, the struts 566 define triangular shapes around openings 568 and the struts can range in number from about 4 to 20 or more. In a typical embodiment, the struts 566 are fabricated by cutting the thin-wall tubing of a spring material and then forming the struts 566 into the relaxed shape as shown in FIG. 4A. In another variation, the struts can be formed from a round, flat or oval spring-type wire elements. The spring elements then can be welded or otherwise bonded to the distal end 570 of the rigid sleeve portion indicated at 572.

As can be further seen in FIGS. 4A and 4B, the resilient structure further comprises an elastomeric material 575, such as silicone, molded over the struts 566. The distal end 572 of the rigid sleeve portion is provided with apertures 578 therein for engaging the over-molded elastomer. In one variation, the elastomer 575 is a substantially transparent material to allow viewing therethrough. In other variations, the elastomer or polymer material may be opaque or non-transparent. The tapered shape of the resilient structure 560 when relaxed as shown in FIG. 4A is configured with a distal opening 580 that has a selected dimension that may range from 10% to 50% of the diameter of the opening 580′ of the structure 560 in its expanded shape a when tensioned as shown s shown in FIG. 4B. The dimension of the distal opening 580 in the tapered configuration of FIG. 4A is selected to allow viewing therethrough with the imaging sensor 125 during insertion of the distal end of the device 100 through a body passageway.

The endoscope sleeve 545 can moved between a proximally retracted position when the resilient structure 560 is in its contracted, tapered configuration as shown in FIG. 4A and a distally advanced position when the resilient structure 560 is in its open, tensioned position as shown in FIG. 4B.

FIGS. 1-3 show the mechanism for moving the resilient structure 560 from the tapered, contracted position of FIG. 4A to the cylindrical position of FIG. 4B. In FIG. 3, it can be seen that the introducer sleeve assembly 550 includes the inner sleeve 555 that is adapted to move axially from a retracted position to the extended position as shown in FIGS. 4B and 5. In other words, the distal movement of the inner sleeve 555 will contact the inner surfaces 582 of the struts 566 and elastomeric material 575 in the tapered position of FIG. 4A and then push the struts 566 outwardly and stretch the elastomeric material 575 to provide the cylindrical shape of FIGS. 4B and 5 as the inner sleeve 555 is fully extended. FIG. 4B shows that the stroke ST of inner sleeve 555 can range from about 5 mm to 20 mm in a typical embodiment.

Referring to FIGS. 1, 3 and 9, the mechanism for moving the inner sleeve 555 from its retracted position to its extended position of FIG. 4B can be understood. In FIGS. 3 and 9, it can be seen that a rotating actuator element 585 is provided which has a cam surface 586 which interfaces with an element 587 of the inner sleeve 555 to move the inner sleeve 555 axially back and forth upon rotation of the finger tab 588 as indicated by arrow AA in FIGS. 1-3. Thus, the finger tab 588 can be designed to move from approximately 45° to 90° to move the inner sleeve 555 in the desired stroke ST as shown in FIG. 4B.

Now turning again to FIG. 4A, in another aspect of the invention, the outer introducer sleeve 552 is configured with a plurality of ports 590 which communicate with the annular space 592 between the outer sleeve 552 and the inner sleeve 555 (see FIG. 6). In one variation, the annular space or outflow channel 592 between the inner and outer sleeves 552, 555 communicates with the negative pressure source 120 and thus provides an outflow path for distention fluid which may be independent of the flow channel through the resecting component 600. In one variation, the negative pressure source 120 comprises a peristaltic pump which suctions fluid through tubing in the pump and where the fluid then flows by gravity into a fluid collection reservoir. In the variation shown in FIGS. 4B and 5, the sleeve assembly 550 has a fluid inflow channel 595 that comprises the space outward of the shaft 610 of the resecting component 600 and within the inner sleeve 555.

In FIG. 6, it can be seen that the distal portion of the inner sleeve 555 includes a polymer over-molded portion 605 (e.g., silicone) which serves two purposes. First, the polymer over-molded portion 605 has an annular ridge 608 which interfaces with the inner surfaces 582 of the struts 566 and elastomeric material 575. The radial height RH of the annular ridge 608 thus provides the annular space 592 between the outer surface of the inner sleeve 555 and the inner surface of the outer sleeve 552 through which distention fluid may be aspirated after flowing through the multiple ports 590 in the outer sleeve 552. Secondly, the annular ridge 608 of the over-molded polymer portion 605 can be adapted to seal the interface between the inner sleeve 555 and the resilient structure 560 so that distention fluid is not aspirated through the distal opening 580′ of the resilient structure 560 in its cylindrical shape as shown in FIG. 6. This aspect of the invention may be useful to prevent any interference with inflows of distention fluid through inflow channel 595. Rather, the variation shown in FIGS. 5 and 6 allows for fluid inflows to exit the resilient structure 560 and opening 580′ around the distal end of the endoscope sleeve 545 which provides the advantage of clearing the visual field distal to the endoscope sleeve 545 to thereby maintain clear viewing. If both inflows and outflows were adjacent to one another in the interior of the resilient structure 560, the clearing of the visual field with fluid inflows could be impaired. In another variation (not shown), the annular ridge 508 could be provided with notches to allow a portion of the fluid outflows into annular space 592 to flow through the distal opening 580′. In a typical embodiment, the negative pressure source 120 would communicate with both the annular space 592 and the aspiration channel 525 in the resecting component 600.

FIGS. 5, 7 and 8 illustrate an electrosurgical tissue-resecting component 600 that is carried in the introducer sleeve assembly 550. The elongated shaft or extension portion 610 has an outer diameter ranging from about 2 mm to 6 mm, and in one variation is about 4 mm to 5 mm in diameter. The shaft 610 extends about its central longitudinal axis 612 to its working end 615 that typically comprises a dielectric housing 620 as can be seen in FIGS. 7 and 8.

The proximal end 621 of the shaft 610 is coupled to the rotatable core 622 shown in FIGS. 1 and 2. A motor drive unit 624 shown in FIGS. 1 and 2 is adapted to reciprocate the electrode 645 as will be described further below. The reciprocation mechanism can be of any type known in the art and FIG. 9 shows a rotating drive sleeve 626 coupled to the motor drive 124 that has a surface (not shown) that rotates against a cam surface 628 coupled to a elongate shaft element connected to the electrode 645. It should be appreciated that the core 622 can be rotated 360° within the handle 162 which will not only rotate the resecting component but also rotate the image sensor 125 positioned at the distal end of the introducer sleeve assembly 550.

Referring to FIG. 7, in general, it can be seen the working end 615 includes the distal end portion 632 of shaft 610 that is coupled to the dielectric housing 620 which has a curved or part-cylindrical surface that has a tissue-receiving window 640 therein. A moveable electrode 645 is adapted to be driven by a motor drive unit 624 in the handle 162 (see FIG. 1) so that the curved electrode 645 can reciprocate across the window 640 from a proximal window end 650 to a distal window end 652 to thereby electrosurgically resect tissue that is captured in the window 640. The targeted tissue can be suctioned into and captured in window 640 by means of a negative pressure source 120 operated by controller 150 that communicates with a tissue extraction channel or aspiration channel 525 extending through the shaft 610 and connects to the window 640.

FIGS. 7 and 8 illustrate the dielectric housing 620 that can comprise a ceramic material such as zirconium oxide, aluminum oxide, silicon nitride or similar materials as are known in the art. Alternatively, the dielectric housing 620 can comprise at least in part a polymer or a glass material. In FIGS. 7-8, it can be seen that window surface has a curvature from side to side that can generally can match the diameter of shaft 610. Correspondingly, the electrode 645 is curved to cooperate with the window surface wherein an inner electrode surface has a radius ranging from 1 mm to 3 mm.

As can be further be seen in FIGS. 7-8, the width W of the window 640 can range from about 2 mm to 6 mm and the window length L can range from about 4 mm to 10 mm. Referring to FIGS. 7-8, one variation of tissue-resecting component 605 has an electrode 645 that can be tungsten or stainless steel wire that with curved electrode adapted to reciprocate across the window 640 at any suitable rate and in an embodiment can range from 1 to 50 Hz or more.

Referring to FIG. 8, in one variation of dielectric housing 620, it can be seen that the electrode 645 has a first lateral side 670 a and a second lateral side 670 b that extends to electrode tip 674. Thus, when moving axially, the lateral sides 670 a and 670 b of electrode 145 extend across the lateral sides or edges 675 a and 675 b of the window 640 to ensure that any tissue captured in the window is resected as the electrode 645 passes the window edges to function like a shear to resect tissue in a scissor-like manner. Further, the stroke SK is adapted cause the electrode 645 to reciprocate across the proximal window end 650 and the distal window end 652 as described above to electrosurgically shear tissue captured in window 640.

Referring to FIG. 7, the electrode 645 is coupled to wire shaft member 680 that extends through sleeve 682 that comprises a portion of the outer surface of shaft 610. The wire shaft member 680 is covered with an insulator sleeve 684 to thus provide an active electrode 645 with limited surface area which lower RF power requirements. The device can include a footswitch or finger switch (not shown) for activating the device wherein such activation would energize the electrode 645 from RF source 160 and also activate the motor drive 624.

Referring again to FIG. 3, the housing 620 is configured with a ledge 690 adjacent the lateral edge 675 b of the window to receive and abut the distal tip 674 of electrode 645 as it reciprocates. The ledge 690 is adapted to prevent the electrode tip 674 from being snagged or caught in tissue.

FIG. 5 shows the introducer sleeve assembly 550 and the resilient structure 560 in its expanded position with the working end 615 of the resecting component 600 advanced through the distal the opening 580′ in the resilient structure 560. As can be understood from FIGS. 2 and 5, the working end of the resecting component 600 is axially movable over stroke SG by means of actuating the thumb grip 695 axially relative to the fixed pistol grip portion 696 of the handle 162 (FIG. 2). At the same time, electrode 645 can be reciprocated to resect tissue as a physician axially and/or rotationally moves the working end 615 of the resecting component 600.

FIG. 8 shows working end 615 of the resecting component 600 from a different angle. In this variation, it can be seen that the window 640 of the working end defines the window surface WS or curved plane across which the electrode 645 reciprocates and cuts tissue. In this variation, the window 640 has a substantially large surface area WS for interfacing with targeted tissue, and the reciprocating electrode 645 in a typical procedure can provide a tissue removal rate that is greater than 5 grams per minute.

As can be understood from FIGS. 1 and 2, the fluid management component 110 includes a fluid source 115 and the negative pressure source 120. Typically, the fluid source comprises a saline bag and a peristaltic pump (not shown) controlled by the controller 150 for providing pressurized inflows into a working space. The negative pressure source 120 is provided typically by a second peristaltic pump controlled by the controller 150 to aspirate fluid and tissue chips through the device into a collection reservoir. Such systems are known in the art and need not be described further herein.

FIGS. 1, 3 and 9 illustrate the inflow and outflow pathways in the interior of the resecting device 100 or 100′ which are coupled to the inflow and outflow pumps of the fluid management component 110 (FIG. 1). As can be seen in FIGS. 3 and 9, a flow channel housing 705 is provided in the handle 162 which includes means for allowing rotation of the rotating core 622 while maintaining the inflow and outflow channels in the sleeve assembly 550 in communication with inflow tubing 710 and outflow tubing 712. It can be seen in FIGS. 3 and 9 that the rotating shaft portion 715 within the flow channel housing 705 includes annular channels 716 a and 716 b with seals 718 a, 718 b and 718 c therebetween, wherein annular channel 716 a communicates with the inflow tubing 710 connected to housing 705 and further communicates with the inflow channel 595 in the sleeve assembly 550 (FIG. 6). Annular channel 716 b communicates with the outflow tubing 712 connected to housing 705 and further communicates with the outflow channel 592 in sleeve assembly 550 (FIG. 6). Thus, it can be understood that the rotating shaft portion 715 within the flow channel housing 705 allows for fluid inflows and outflows as the core 622 core is rotated.

Now turning to FIGS. 4A and 5, the endoscopic viewing component comprises the distal imaging sensor 125 and lens 130 carried at the end of the endoscope sleeve 545. The endoscope sleeve 545 typically may be axially translatable within the shaft as shown in FIGS. 4A-4B. The mechanism for advancing the endoscope sleeve 545 can be thumb grip 695 which advances the endoscope sleeve 545 a predetermined distance and then stops its advancement. Further advancement and retraction of the thumb grip 695 then is adapted to translate the working end 615 of the resecting component 600 back and forth. In one variation, the endoscope sleeve 545 comprises a thin-wall tubular member of a (e.g., a metal or polymer) with the image sensor 125 and lens 130 positioned in a distal end thereof. A plurality of electrical conductors 722 are carried in passageway 724 of the sleeve 545 that are coupled to the image sensor 125. The conductors 722 can be in a flex circuit or can be in any suitable cable. Such conductors 722 carry signals from the image sensor to the image processor 140 which is in the base unit 145 but optionally can be carried in the handle 162. The entire sleeve 545 and lens 130 is encased in an insulator coating or shielding 725 that has sufficient insulative strength to shield the image sensor 125 and signals carried. by conductors 722 from any potential electrical interference from RF current carried to the working end of the resection device or from current carried to the motor 124. The insulator coating 725 is a type that is transparent for covering the lands 130 to allow viewing therethrough. In one variation, the insulator coating 725 extends over the entire length of the sleeve 525 as well as over any length of the conductors 722 that extend through the handle 162. The image sensor 125 may be any electronic imaging chip known in the art with a suitable lens 130 which are available, for example, from Omni Vision, 4275 Burton Drive, Santa Clara, Calif. 95054 such as a High Definition Sensor used in cell phones and laptops.

In one variation, still referring to FIGS. 4B and 5, the endoscopic sleeve 545 further includes at least one LED 740 or other light source carried at the distal end of the sleeve. Of particular interest, the rotating core 622 is adapted to carry the image sensor 125 and the LEDs 740 together with the resecting component 600 thus allowing 360° rotation. Electrical leads 742 are also carried in the passageway 724 of the sleeve 545 which extend to LED source 160 (FIG. 1). The shielding 725 described above also protects the LEDs from interference by the RF source or motor source.

In another variation, the system can include at least one LED 740 that is adapted for providing multiple wavelengths or frequencies, and can be tuned by user inputs at the controller, for example, to provide white light, blue light or red light. In such a variation, the image sensor can be configured with a digital filter to correct the image on a monitor. Such tuning of the at least one LED 740 will be useful in the event that a laser treatment device is used to irradiate a bladder tumor, such as a blue light laser.

Now turning to FIGS. 9, 10 and 11, another variation of resecting device 100′ is shown which is similar to that of FIGS. 1-6 except the resecting component 600′ has a different variation of a working end 800. The working end 800 of the RF tissue-resecting component 600′ again has an elongated extendable shaft 805 that carries a dielectric housing 810 with a reciprocating electrode 815 (see FIG. 10). In this variation, the dielectric housing 810 which carries the window 820 has an offset portion 822 that extends outward from the cylindrical surface 824 of the elongated shaft 805 the resecting component. In this variation, the offset window 820 and electrode 815 allows for improved endoscopic viewing of the electrode 815 when being reciprocated. The stroke of the electrode 815 is indicated at ST which is then easily observed within the field of view FOV (see FIG. 10).

FIG. 10 further shows that the image sensor 125 and lens 130 are carried in a first independent tubular sleeve 825 in this variation. Similarly, the single LED 828 is carried in a second independent tubular sleeve 830 in the introducer sleeve assembly 550. The use of independent sleeves 825 and 830 allow for compact design while still allowing for a fluid outflow channel 832 which comprises the space around the sleeves 825, 830.

FIG. 11 is a schematic view of device handle 162, sleeve assembly 550 and the first tubular sleeve 825 that carries the image sensor 125 and lands 130. The schematic view of FIG. 11 illustrates more details of the electromagnetic shielding around the sleeve 825. It can be seen that a dielectric layer 840, such as a heat shrink tubing, is provided around the entire length of the metal or other electrically conductive sleeve 825 which extends into the handle as can be seen in FIG. 9. In one variation, the dielectric layer 840 is PET having a thickness of at least 0.001″ or at least 0.002″. The electrically conductive sleeve 825 provides the desired electrical shielding while the dielectric layer electrically isolates the sleeve. Further, another cap layer 842 of a transparent dielectric shielding material can extend around the lens 130 at the distal end 844 of the sleeve 825. Such a cap layer 842 can be bonded with adhesives or other sealing means to the tubular dielectric layer 840. Alternatively, the lens can be configured with a dielectric surface (e.g., glass or polymer) to provide an adequate dielectric layer. FIG. 11 further shows electrical conductors 850 extending from the image sensor 125 through the elongated sleeve 825 to the proximal end 852 thereof which is also encased in a cap layer 855 the dielectric material. The electrical conductors can be in a co-axial cable with dielectric layers around each conductor or it can be a flex circuit. Electrical conductors 850 are then connected to a circuit board 860 carried in the handle 162 of the device as can be seen in FIG. 9. An insulated electrical cable 862 carries image signals from the circuit board 860 to the image processor 140. By this means, it can be seen that the signal carrying electrical conductors 850 are encased in electromagnetic shielding the entire distance from the distal image sensor 125 to the circuit board 860 and thereafter to the remote image processor 140. As shown schematically in FIG. 11, elongated sleeve 825 may be surrounded by fluid outflows F in outflow channel 832 which can aggravate electromagnetic interference, and the dielectric layers 840, 842 and 855 can shield the image sensor 125 and conductors 850 from potential interference since the dielectric material covers all surfaces of the sleeve 825 carrying the image sensor and conductors 850. FIG. 11 further shows a seal 866 around the sleeve 825 that prevents fluid flows into the handle 162.

FIG. 11 also shows the second independent sleeve 830 that carries the LED 828 in a schematic view. It should be appreciated that the second sleeve 830 and LED 828 are encased in shielding of the same type as shown in more detail in FIG. 11 relating to the first independent sleeve 825 that carries the image sensor 125. FIG. 11 shows that electrical conductors 870 extend from the LED source 160 to the circuit board 860 and thereafter to the second independent sleeve 830 to power the LED 828. A fluid seal 872 is also shown schematically around independent sleeve 830 to prevent fluid flows from extending into the handle 162.

Now referring to FIGS. 9 and 11, an additional electrically conductive shielding member 880 is provided in the handle 162 to shield the circuit board 860 from the motor 124 and the electrical cable 875 (FIG. 11) that extends from the RF source 155A to the electrode 815 at the working end 800 of the resecting device 100′ (see FIG. 10). Thus, the additional RF shielding member 880 can ensure that the electrical current driving the motor 124 and the resecting device cannot interfere with signals from the image sensor 125.

Now turning to FIG. 12 and FIGS. 13A-13D, a method of the invention is shown relating to the resection of a bladder tumor using the device 100′ of FIGS. 9 and 10. In FIG. 12, a bladder 904 of a male is shown together with the prostate 905 and prostatic urethra 906. The bladder wall 908 includes the urothelium layer 910, the connective tissue layer 912, the muscle layer 915, the perivesical layer 916 and the peritoneum 918. The shaft assembly 550 of the device of FIGS. 9 and 10 is shown after introduction through the patient's urethra 908 into the interior of the bladder 904. A bladder tumor 920 is shown in FIGS. 12 and 13A. It should be appreciated that bladder tumors are identified as different types or categories wherein type Ta indicates a noninvasive papillary carcinoma. Tis indicates a type of noninvasive flat carcinoma, also called flat carcinoma in situ, which means the disease is localized or contained within the urothelium layer 910 of the bladder wall. Category T1 means the tumor has grown from the urothelial layer of cells lining the bladder into the connective tissue layer 912 below, but has not grown into the muscle layer 915 of the bladder. Category T2 means the tumor has grown into the muscle layer 915. Category T3 means the tumor has grown through the muscle layer 915 and into the surrounding fatty tissue or perivesical layer 916. Category T4 means the tumor has spread into nearby organs or structures.

FIGS. 11 and 12A illustrate a type T1 tumor in the urothelium 910 and connective tissue layer 912. The device of the invention is adapted to treat smaller tumors such as type T1 and T2 bladder tumors that can be resected together with a suitable margin around and under the tumor under direct observation from the endoscope. In FIG. 12, it can be seen that the field of view FOV of the imaging sensor is adapted for viewing the working end and reciprocating electrode of the device.

FIG. 13A shows working end 800 being moved close to the bladder tumor 920 with the electrode 815 in a stopped position relative to the window 820 in the dielectric housing 810. FIG. 13B shows the working end 800 of the device being advanced into the tumor 920 and reciprocation of the electrode 815 across the cutting window 820 to thereby resect tissue chips 922 which are suctioned into outflow passageway 925 which communicates with the fluid outflow source 120 (or negative pressure source).

In one variation, the resecting component 600′ is adapted to cause a single stroke or single reciprocation of the electrode 815 to cut a single tissue chip. The single actuation or reciprocation of the electrode 815 can be performed by a foot switch or finger-actuated switch (not shown) in the handle. It is useful to resect a single tissue chip 922 from a bladder tumor 920 to insure that each reciprocation is observable by the physician and to insure that the resecting depth is limited. The bladder wall 908 can be thin, for example from 4 mm to 10 mm, and the physician needs a system for controlled superficial cutting. Turning now to FIG. 13C, it can be seen that the working end 800 is manipulated further towards the tumor 920 and the electrode 815 is reciprocated intermittently to cut tissue chips 922 which are extracted through the fluid extraction channel or outflow passageway 925 of the device to a tissue collecting filter as is known in the art. As can be seen in FIG. 13C, the tumor 920 is largely removed. FIG. 13D shows that the tumor 920 and a tissue margin has been resected as the working end 800 is moved away from the bladder wall 908. By using this method of reciprocating the electrode intermittently, the physician can finely control the depth o resection to determine for removal of the tumor 920 together with safety margins.

In another aspect of the invention, still referring to FIGS. 12 and 13A-13D, it has been found that a small diameter electrode 815 is optimal for resecting bladder tumors 920 to create very fine cutting that is needed for such tumors. In one variation, the electrode diameter is less than 0.020″. In another variation, the wire electrode diameter is than 0.018″ or less than 0.015″. As can be understood from FIGS. 13B and 13C, the tissue chips that are resected are extracted with fluid flows through the extraction channel 925 which can be captured in a tissue catch in the fluid outflow line of the device. The tissue chips are adequate in size for biopsy purposes.

In general, a method of the invention for resecting bladder tumor 920 comprises providing a probe 100′ with an elongated shaft extending to a working end 800 having a tissue-receiving window 820 with a motor-driven electrode 815 that moves across the window, introducing the working end 800 into a bladder 904 proximate the targeted tumor 920, and actuating movement of the electrode 815 in a single stroke across the window to resect a portion of the tumor which can be collected as a biopsy sample.

In this method, the actuating step can move the electrode 815 from a first side of the window to an opposing second side of the window. In another variation, the actuating step can move the electrode from a first side of the window to an opposing second side thereof and back to said first side. The actuating step can be triggered by a foot switch or finger switch to move or reciprocate the electrode 815, which can be controlled by a controller. In another variation, the controller can include a selection mechanism which provides that the electrode 815 can be actuated in a preselected number of strokes, for example 1 to 50.

In one variation, the method includes using a controller that allows for selecting a predetermined level of suction or fluid outflow provided by the negative pressure source communicating with the window. In another variation, the method includes using a controller that allows for selecting a predetermined speed of electrode movement across the window. The actuating step can move the electrode across the window at a rate equivalent to 1 Hz to 50 Hz.

In another aspect of the system, the working end 800 and a controller can include a sensing mechanism for sensing electrode contact with target tissue wherein actuation of the electrode both in terms of movement and energy delivery can be triggered by such electrode contact with tissue. Such electrode contact can be determined by monitoring an electrical parameter which acts as an indicator of such contact. For example, a low level direct or RF current may be delivered to the electrode, where a detectable change in the current delivery will occur as the electrode contacts tissue.

For example, a surgical system for treating targeted tissue in a saline-filled working space may comprise a probe with an elongated shaft extending to a working end having a tissue-receiving window that opens to a passageway in the shaft, an electrode driven by a motor to move across the window to resect tissue, an RF source coupled to the electrode, and a controller operatively connected to the motor and the RF source wherein the controller actuates movement of the electrode in response to electrode contact with the targeted tissue. The controller of the surgical system is also configured to deliver energy to the electrode on tissue contact. Further, the controller can determine electrode-tissue contact by monitoring an electrical parameter of current delivered to the electrode, where current is delivered from at least one of the RF source or a DC source. The electrical parameter determined by the controller can be selected from the group impedance, capacitance and phase angle. The controller can monitor the electrical parameter for a selected threshold level of or for a change in any one or more of impedance, capacitance, and phase angle.

As described above, the surgical system further comprises a negative pressure source coupled the passageway adapted for suctioning tissue into the window for resection with the electrode, wherein the motor drive is adapted to move the electrode across the window at a rate ranging from 1 Hz to 50 Hz. In one variation, the surgical system includes an algorithm further adapted to modulate negative pressure in response to an electrical parameter relating to at least one of impedance, capacitance and phase angle.

The surgical system the controller may further include a stop mechanism for stopping movement of the electrode at the first side or the opposing second side of the window. Such a stop mechanism may be adapted to stop the motor in response to signals from at least one of a position switch, an encoder coupled to the motor, a stepper motor, an optical sensors or a Hall effect sensor. In other variations, the system includes a selector mechanism coupled to the controller for selecting a predetermined level of suction provided by the negative pressure source and/or for selecting a predetermined speed of electrode movement.

The system described above can be adapted or configured to initiate a single stroke or a single reciprocating movement of the electrode in response to each initiation event. Alternatively, the system of the present invention can be adapted or configured to initiate a pre-determined number of strokes or reciprocating movements of the electrode (e.g., 1 to 50) in response to each initiation event. In other variations, the system can be configured continue reciprocation of the electrode in response to an initiation event until the physician terminates the energy delivery and electrode movement, e.g., by releasing a foot switch or finger-operated trigger. In another variation, the controller algorithm of the surgical system may be adapted to stop movement of the electrode in response to an electrical parameter relating to at least one of impedance, capacitance and phase angle.

In another aspect of the invention, the system can modulate negative pressure in the window to thereby adjust the dimensions of the tissue chip. As can be understood, a greater negative pressure can suction a tissue further into the window to thereby allow the electrode to resect a larger volume tissue chip. Conversely, lesser negative pressure will provide for resection of a thinner tissue chip having less volume. In general, surgical system for obtaining a biopsy sample in a fluid-filled working space comprises a probe with an elongated shaft extending to a working end having a tissue-receiving window that opens to a passageway in the shaft connected to a negative pressure source, a moveable electrode adapted to move across the window to resect tissue suctioned into the window and a controller adapted activate the negative pressure source at at least first and second negative pressure levels for suctioning different volumes of tissue into the window to thereby provide different volume biopsy samples. The system further has a controller the is adapted to control a motor drive for moving the electrode across the window, for example, at a rate equivalent to 1 Hz to 50 Hz. The controller is further adapted to control the RF source operatively coupled to the electrode. The first and second negative pressure levels can provide flow rates within the range of 50 ml/min to 1000 ml/min.

In another variation, a distal region of the sleeve assembly 550 of the device FIG. 10 can be configured for articulation. In such a variation, the independent sleeves 825, 830 that carry the image sensor and the at least one LED would articulate. Also, the shaft 805 of the resecting component 600′ would articulate. In another variation, the sleeve 825 that carries the image sensor 130 can be configured to extend distally as well as articulate to increase the potential of viewing angles in treatment of bladder tumors. In such a variation, the sleeve assembly 550 in the shaft 805 of the resecting device 600′ can comprise non-articulating components.

Preferred embodiments of this invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of those preferred embodiments may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context. 

What is claimed is:
 1. A surgical system for treating targeted tissue in a fluid-filled working space comprising: a probe with an elongated shaft extending to a working end having a tissue-receiving window that opens to a passageway in the shaft; an electrode; a motor configured to move the electrode across the tissue-receiving window to resect tissue; a current source configured to be coupled to the electrode; and a controller operatively connected to the motor and the current source wherein the controller initiates movement of the electrode in response to contact of the electrode with the targeted tissue.
 2. The surgical system of claim 2 wherein the current source comprises an ablative radiofrequency (RF) current source and at least one of a low level RF source and a low level direct current (DC) source.
 3. The surgical system of claim 2 wherein the controller is configured to determine electrode-tissue contact by monitoring an electrical parameter of a low-level current delivered to the electrode.
 4. The surgical system of claim 3 wherein the electrical parameter comprises at least one of impedance, capacitance and phase angle.
 5. The surgical system of claim 3 wherein the electrical parameter comprises a selected threshold level of at least one of impedance and capacitance.
 6. The surgical system of claim 3 wherein the electrical parameter comprises a rate of change of at least one of impedance and capacitance.
 7. The surgical system of claim 1 further comprising a negative pressure source coupled the passageway adapted for suctioning tissue into the window.
 8. The surgical system of claim 1 wherein the motor drive is adapted to move the electrode across the window at a rate ranging from 1 Hz to 50 Hz.
 9. The surgical system of claim 1 wherein the controller is further adapted to stop movement of the electrode in response to an electrical parameter comprising at least one of impedance, capacitance and phase angle.
 10. The surgical system of claim 7 wherein the controller is further adapted to modulate negative pressure in response to an electrical parameter relating to at least one of impedance, capacitance and phase angle.
 11. A method of treating targeted tissue in a fluid-filled working space comprising: providing a probe with an elongated shaft extending to a working end having a tissue-receiving window with a motor-driven electrode that moves across the window; introducing the working end into the working space proximate the targeted tissue; actuating movement of the electrode in response to electrode contact with the targeted tissue; and delivering current to the electrode to ignite a plasma around the electrode; resecting tissue with the electrode and plasma.
 12. The method of claim 11 further comprising the step of activating a negative pressure source communicating with a passageway in the shaft and the window to suction tissue into the window.
 13. The method of claim 12 wherein the actuating step includes utilizing a controller configured to determine electrode-tissue contact by monitoring an electrical parameter of current delivered to the electrode.
 14. The method of claim 12 wherein the electrical parameter comprises a selected level of at least one of impedance and capacitance.
 15. The method of claim 12 further comprising the step of stopping movement of the electrode in response a selected level of at least one of impedance and capacitance.
 16. The method of claim 12 further comprising the step of modulating negative pressure in response to a selected level of at least one of impedance and capacitance.
 17. The method of claim 12 wherein actuating step moves the electrode across the window at a rate ranging from 1 Hz to 50 Hz.
 18. A surgical system for obtaining a biopsy sample in a fluid-filled working space, comprising: a probe with an elongated shaft extending from a proximal end to a working end having a tissue-receiving window that opens to a passageway in the shaft; an electrode; a motor configured to move the electrode across the tissue-receiving window to resect tissue; and a controller adapted energize the electrode and actuate movement of the electrode in a single stroke across the window to resect a tissue sample.
 19. The surgical system of claim 18 further comprising a negative pressure source coupled the passageway adapted for suctioning tissue into the window.
 20. The surgical system of claim 19 wherein the single stroke consists of electrode movement from a first side of the window to an opposing second side of the window.
 21. The surgical system of claim 19 wherein the single stroke consists of electrode movement from a first side of the window to an opposing second side thereof and back to said first side.
 22. The surgical system of claim 20 further comprising a stop mechanism for stopping movement of the electrode at the first side or the opposing second side of the window.
 23. The surgical system of claim 18 further comprising a selector mechanism coupled to the controller for selecting a predetermined number of strokes ranging from 1 to
 50. 24. The surgical system of claim 18 further comprising a selector mechanism coupled to the controller for selecting a predetermined level of suction provided by the negative pressure source.
 25. The surgical system of claim 18 further comprising a selector mechanism coupled to the controller for selecting a predetermined speed of electrode movement.
 26. The surgical system of claim 22 wherein the stop mechanism is adapted to stop the motor in response to signals from at least one of a position switch, an encoder coupled to the motor, a stepper motor, an optical sensors or a Hall effect sensors.
 27. A method of obtaining a biopsy sample in a fluid-filled working space, comprising: providing a probe with an elongated shaft extending to a working end having a tissue-receiving window with a motor-driven electrode that moves across the window; introducing the working end into the working space proximate the targeted tissue; and actuating movement of the electrode in a single stroke across the window to resect a biopsy sample.
 28. The method of claim 27 wherein the actuating step moves the electrode from a first side of the window to an opposing second side of the window.
 29. The method of claim 27 wherein the actuating step moves the electrode from a first side of the window to an opposing second side thereof and back to said first side.
 30. The method of claim 27 wherein the actuating step is controlled by a controller.
 31. The method of claim 29 further comprising the step of selecting on the controller a predetermined number of strokes ranging from 1 to
 10. 32. The method of claim 29 further comprising the step of selecting on the controller a predetermined level of suction provided by a negative pressure source communicating with the window.
 33. The method of claim 27 further comprising the step of selecting on the controller a predetermined speed of electrode movement across the window.
 34. The method of claim 27 wherein actuating step moves the electrode across the window at a rate equivalent to 1 Hz to 50 Hz.
 35. A surgical system for obtaining a biopsy sample in a fluid-filled working space comprising: a probe with an elongated shaft extending to a working end having a tissue-receiving window that opens to a passageway in the shaft connected to a negative pressure source; a moveable electrode adapted to move across the window to resect tissue suctioned into the window; and a controller adapted activate the negative pressure source at at least first and second negative pressure levels for suctioning different volumes of tissue into the window to thereby provide different volume biopsy samples.
 36. The surgical system of claim 35 wherein the controller is further adapted to control a motor drive for moving the electrode.
 37. The surgical system of claim 36 wherein the motor drive is adapted to move the electrode across the window at a rate equivalent to 1 Hz to 50 Hz.
 38. The surgical system of claim 35 wherein the controller is further adapted to control an electrical source operatively coupled to the electrode.
 39. The surgical system of claim 35 wherein the first and second negative pressure levels can be in the range of 50 ml/min to 1000 ml/min. 